Headache in long COVID as disabling condition: A clinical approach.

Background and purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can exacerbate previous headache disorders or change the type of pain experienced from headaches. This study aimed to investigate the clinical features of Long COVID headaches. Method: This was a cross-sectional, descriptive, and analytical observational study that included 102 patients (with previous headache, n = 50; without previous headache, n = 52) with long COVID and headache complaints. The Migraine Disability Assessment Test and Visual Analog Pain Scale were used to collect participants' headache data according to a standardized protocol. Results: The patients in this study who reported experiencing headaches before COVID-19 had longer headache duration in the long COVID phase than that in the pre-long COVID phase (p = 0.031), exhibited partial improvement in headache symptoms with analgesics (p = 0.045), and had a duration of long COVID of <1 year (p = 0.030). Patients with moderate or severe disability and those classified as having severe headaches in the long COVID phase were highly likely to develop chronic headaches. Hospital admission [odds ratio (OR) = 3.0082; 95% confidence interval (95% CI): 1.10-8.26], back pain (OR = 4.0017; 95% CI: 1.13-14.17), insomnia (OR = 3.1339; 95% CI: 1.39-7.06), and paraesthesia (OR = 2.7600; 95% CI: 1.20-6.33) were associated with headache in these patients. Conclusion: Headache is a disabling condition in patients with long COVID-19, exacerbating the conditions of those with headaches prior to contracting COVID-19.

Persistent olfactory dysfunction associated with poor sleep quality and anxiety in patients with long COVID.

Introduction: Poor sleep quality have been widely reported in patients with long COVID. Determining the characteristics, type, severity, and relationship of long COVID with other neurological symptoms is essential for the prognosis and management of poor sleep quality. Methods: This cross-sectional study was conducted at a public university in the eastern Amazon region of Brazil between November 2020 and October 2022. The study involved 288 patients with long COVID with self-report neurological symptoms. One hundred thirty-one patients were evaluated by using standardised protocols: Pittsburgh sleep quality index (PSQI), Beck Anxiety Inventory, Chemosensory Clinical Research Center (CCRC), and Montreal Cognitive Assessment (MoCA). This study aimed to describe the sociodemographic and clinical characteristics of patients with long COVID with poor sleep quality and their relationship with other neurological symptoms (anxiety, cognitive impairment, and olfactory disorder). Results: Patients with poor sleep quality were mainly women (76.3%), 44.04 ± 12.73 years old, with >12 years of education (93.1%), and had monthly incomes of up to US $240.00 (54.2%). Anxiety and olfactory disorder were more common in patients with poor sleep quality. Discussion: Multivariate analysis shows that the prevalence of poor sleep quality was higher in patients with anxiety, and olfactory disorder is associated with poor sleep quality. In this cohort of patients with long COVID, the prevalence of poor sleep quality was highest in the group tested by PSQI and were associated with other neurological symptoms, such as anxiety and olfactory dysfunction. A previous study indicates a significant association between poor sleep quality and psychological disorders over time. Recent studies involving neuroimaging found functional and structural changes in Long COVID patients with persistent olfactory disfunction. Poor sleep quality are integral part of complex changes related to Long COVID and should be part of patient's clinical management.

Malaria and environmental, socioeconomics and public health conditions in the municipality of São Félix do Xingu, Pará, Eastern Amazon, Brazil: An ecological and cross-sectional study.

BACKGROUND: Malaria is a parasitosis conditioned by several factors. This study sought to analyze the spatial distribution of malaria considering environmental, socioeconomic, and political variables in São Félix do Xingu, Pará, Brazil, from 2014 to 2020. METHODS: Epidemiological, cartographic, and environmental data were obtained from the Ministry of Health, Brazilian Geographical and Statistical Institute, and National Space Research Institute. Statistical and spatial distribution analyses were performed using chi-squared tests of expected equal proportions and the kernel and bivariate global Moran's techniques with Bioestat 5.0 and ArcGIS 10.5.1. RESULTS: The highest percentage of cases occurred in adult males with brown skin color, mainly placer miners, with a primary education level, living in rural areas, who were infected with Plasmodium vivax and with parasitemia of two or three crosses as diagnosed by the thick drop/smear test. The disease had a non-homogeneous distribution, with distinct annual parasite indices associated with administrative districts and clusters of cases in locations with deforestation, mining, and pastures close to Conservation Units and Indigenous Lands. Thus, a direct relationship between areas with cases and environmental degradation associated with land use was demonstrated, along with the precarious availability of health services. Pressure on protected areas and epidemiological silence in Indigenous Lands were also noted. CONCLUSIONS: Environmental and socioeconomic circuits were identified for development of diseases associated with precarious health services in the municipality. These findings highlight the need to intensify malaria surveillance and contribute to the systematic knowledge of malaria's epidemiology by considering the complexity of its conditioning factors.

Diretivas antecipadas de vontade como temática da educação médica / Advance directives as a topic in medical education / Voluntades anticipadas como tema de la educación médica

Resumo A pesquisa investigou o conhecimento de professores e alunos do internato médico acerca das diretivas antecipadas de vontade, que visam assegurar os direitos dos pacientes de registrar sua preferência pelos cuidados médicos a que serão submetidos quando estiverem incapacitados de tomar decisões. Trata-se de estudo transversal, descritivo, observacional, com abordagem majoritariamente quantitativa, que contou com a participação de 30 professores do curso de medicina e 121 acadêmicos de medicina vinculados a duas instituições de ensino localizadas em Belém/PA. Os resultados revelaram lacunas no conhecimento a respeito do tema, apontando a necessidade de uma abordagem mais aprofundada durante a formação e a prática médica. Conclui-se que é necessário intensificar a divulgação de diretivas antecipadas de vontade no âmbito do ensino médico, de forma a favorecer a autonomia e o compartilhamento das decisões.

Abstract This study investigated the knowledge of medical professors and students during internship regarding advance directives, a device that aims to ensure the right of patients to record their preference for medical care they will be subject to when incapable of making decisions. This is a cross-sectional, descriptive and observational study with a mostly quantitative approach, of which participated 30 professors and 121 medical students from two teaching institutions in Belém/PA. The results identified gaps in the knowledge about the topic, pointing to the need for a deeper approach during medical training and practice. It is concluded that the divulging of advance directives in medical training should be more intense to favor autonomy and share decision making.

Resumen Esta investigación analizó el conocimiento de profesores y estudiantes de medicina sobre las directivas anticipadas, cuyo objetivo es garantizar los derechos de los pacientes a expresar su preferencia por la atención médica cuando ya no son capaces de comunicarse. Se trata de un estudio transversal, descriptivo, observacional, con enfoque mayoritariamente cuantitativo, en el que participaron 30 profesores de medicina y 121 estudiantes de medicina de dos instituciones de enseñanza situadas en Belém/PA. Los resultados revelaron vacíos en el conocimiento sobre el tema, lo que demuestra la necesidad de un abordaje en profundidad durante la formación y la práctica médica. Se concluye que hay una necesidad de intensificar el conocimiento de las voluntades anticipadas en la formación médica para favorecer la autonomía y la toma de decisiones compartida.

Malaria and environmental, socioeconomics and public health conditions in the municipality of São Félix do Xingu, Pará, Eastern Amazon, Brazil: An ecological and cross-sectional study

ABSTRACT Background: Malaria is a parasitosis conditioned by several factors. This study sought to analyze the spatial distribution of malaria considering environmental, socioeconomic, and political variables in São Félix do Xingu, Pará, Brazil, from 2014 to 2020. Methods: Epidemiological, cartographic, and environmental data were obtained from the Ministry of Health, Brazilian Geographical and Statistical Institute, and National Space Research Institute. Statistical and spatial distribution analyses were performed using chi-squared tests of expected equal proportions and the kernel and bivariate global Moran's techniques with Bioestat 5.0 and ArcGIS 10.5.1. Results: The highest percentage of cases occurred in adult males with brown skin color, mainly placer miners, with a primary education level, living in rural areas, who were infected with Plasmodium vivax and with parasitemia of two or three crosses as diagnosed by the thick drop/smear test. The disease had a non-homogeneous distribution, with distinct annual parasite indices associated with administrative districts and clusters of cases in locations with deforestation, mining, and pastures close to Conservation Units and Indigenous Lands. Thus, a direct relationship between areas with cases and environmental degradation associated with land use was demonstrated, along with the precarious availability of health services. Pressure on protected areas and epidemiological silence in Indigenous Lands were also noted. Conclusions: Environmental and socioeconomic circuits were identified for development of diseases associated with precarious health services in the municipality. These findings highlight the need to intensify malaria surveillance and contribute to the systematic knowledge of malaria's epidemiology by considering the complexity of its conditioning factors.

Conhecimento de Estudantes de Medicina sobre Suporte Básico de Vida no Atendimento à Parada Cardiorrespiratória / Medical Student Knowledge about Basic Life Support in the Attendance of Cardiorespiratory Arrest Care

Resumo: Introdução: A parada cardiorrespiratória (PCR) é caracterizada pela interrupção brusca da circulação sistêmica e da respiração. Devido à redução de oxigênio e de nutrientes para os tecidos corporais, há maior risco de morte do indivíduo, o que torna a PCR uma grave emergência médica. Nesse contexto, a correta realização do suporte básico de vida no atendimento pré-hospitalar (APH) é de fundamental importância para diminuir a taxa de mortalidade e as sequelas em vítimas de PCR. Considerando a importância do assunto no ensino médico, o presente estudo teve o objetivo de identificar os conhecimentos dos estudantes de medicina sobre o tema, de modo a verificar se os discentes reconhecem os sinais indicativos de parada cardiorrespiratória; a sequência de medidas aplicadas durante o atendimento pré-hospitalar de vítimas em PCR e as técnicas indicadas para prestação do atendimento. Método: Trata-se de uma abordagem observacional, exploratória, descritiva e quantitativa, com uma amostra constituída por 245 alunos do curso de medicina da Universidade Estadual do Pará. Na realização da coleta de dados foi utilizado um questionário contendo 18 questões, aplicado por meio da Plataforma Google Forms. Resultados: O conhecimento foi satisfatório, com acertos significativos nos semestres mais avançados do curso. Os conhecimentos mais limitados incluíram o manejo da técnica de compressão, uso correto do DEA e manobras de retificação das vias aéreas. Conclusões: Apesar da quantidade significativa de acertos, observou-se a necessidade de uma melhor abordagem do tema durante a formação médica, a fim de possibilitar a correta realização do atendimento pré-hospitalar às vítimas de PCR, haja vista sua importância nos cenários de urgência e emergência.

Abstract: Introduction: Cardiorespiratory Arrest (CRA) is characterized as an interruption or reduction of mechanical activity of the heart and breath activity. As a result of reduction of oxygen and nutrients for the corporal tissue, there is risk of death, which makes the CRA a severe medical emergency. In this context, the correct performance of basic life support in prehospital treatment is of fundamental importance to diminish the mortality rate and complications in CRA victims. Considering the importance of the topic in medical teaching, the present study was aimed at identifying the knowledge of medical students about the subject, in a way to verify whether the students know how to identify the signals that indicate a cardiorespiratory arrest, the sequence of measures applied during the prehospital care of CRA victims, and the adequate techniques for the medical procedure. Method: The present study adopted an observational, exploratory, descriptive and quantitative approach, with a sample of 245 students of the medicine course at Universidade Estadual do Pará. To collect the samples, one quiz containing 18 questions was used and applied with Google Forms. Results: The knowledge of the students was satisfactory, with significant increase of performance at later periods of the course. The more limited knowledge included the management of compression techniques; the correct use of the automated external defibrillator (AED) and airway management. Conclusions: Although there was a high amount of hits, the necessity of a better approach on the topic was observed during medical training, to enable the correct prehospital treatment of CRA victims, due to the importance of such procedure in medical emergency.